Male Questionnaire
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There are risk factors associated with certain conditions that your relatives may have had: if you know of any, please tell us here.

NOTE: 'Close' relatives are brothers, sisters, parents or grandparents.

Q912

Allergies in close family members?
  • None / don't know
  • Minor in one parent
  • Minor in two parents or significant in one
  • Significant in two parents
  • Severe in two parents

Q913

Alzheimer's Disease in close family members?
  • None / don't know
  • Probably in one family member
  • Probably in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q914

Cancer of ANY type in close family members?
  • None / don't know
  • Probably, one family member
  • Probably, more than one family member
  • Yes, one family member
  • Yes, more than one family member

Q915

Melanoma (a dangerous form of skin cancer) in close family members?
  • None / don't know
  • Probably, in one parent or sibling
  • Probably, in two or more parents or siblings
  • Yes, in one parent or sibling
  • Yes, in more than one parent or sibling

Q916

Cancer of the colon / rectum in close family members?
  • None / don't know
  • Probably, in parent(s) or sibling(s)
  • Yes, in one parent or sibling
  • Yes, in more than one parent or sibling

Q917

Chronic Fatigue in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q918

Colitis (inflammation of the colon) or Ulcerative Colitis in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q919

Depression in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q920

Diabetes in either distant or close relatives?
  • None / don't know
  • Yes, in a distant relative
  • Yes, in 1 direct or 2 distant relatives
  • Yes, in 2 direct relatives
  • Yes, in more than 2 direct relatives

Q921

If your father ever suffered Heart Attack(s), at approximately what age did they start?
  • Never / don't know
  • Over 60
  • 51-60
  • 41-50
  • 40 or younger

Q922

If your mother ever suffered Heart Attack(s), at approximately what age did they start?
  • Never / don't know
  • Over 80
  • 71-80
  • 61-70
  • 60 or younger

Q923

Aside from Heart Attacks, has there been any heart disease in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q924

Did either of your parents suffer from Hypertension?
  • None / don't know
  • Mild in one parent
  • Both parents mild or one parent moderate
  • Both parents moderate or one parent high
  • Both parents high or one parent severe

Q925

Hyperthyroidism in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q926

Hypothyroidism in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q927

Kidney Stones in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q928

Glaucoma in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q929

Macular Degeneration (any type) in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q930

Muscle pains in close family members?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one family member
  • Yes, in more than one family member

Q931

Schizophrenia in close family members?
  • None / don't know
  • Yes, in one distant relative
  • Yes, in one direct relative or 2 distant relatives
  • Yes, in 2 direct relatives
  • Yes, in more than 2 direct relatives

Q932

Stroke in close family members?
  • None / don't know
  • Yes, in one distant relative
  • Yes, in more than one distant relative
  • Yes, in one direct relative
  • Yes, in more than one direct relative

Q933

Tuberculosis in family members that you live with?
  • None / don't know
  • Probably, in one family member
  • Probably, in more than one family member
  • Yes, in one or more family members
  • Yes, in more than one generation of family members